Health care costs in the United States exceed 14 percent of the gross domestic product, far more than in any other nation. Overall costs were $838 billion in 1992, or over $3,000 per person. Well over 30 million Americans are uninsured, partly because of rising premium costs. We propose an approach to part of this problem that has been neglected, one that focuses on systematically reducing the need and thus the demand for medical services. This approach requires expanding the definitions of “health promotion” and “preventive care,” paying selective attention to strategies that have been found to result in net cost savings.